Prophylactic rectal indomethacin may be ineffective for preventing post‐endoscopic retrograde cholangiopancreatography pancreatitis in general patients: A meta‐analysis

Abstract

In a contemporary meta-analysis of available randomized controlled trials of consecutive patients undergoing ERCP, rectal indomethacin did not show significant prevention effect of post-ERCP pancreatitis.

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

“…A recent meta-analysis suggested that RNSAIDs do not protect against PEP in average-risk patients. 134 The landmark multicenter study Elmunzer et al 135 studied high-risk patients of which > 80% also received PPS. The protective effect was limited to one center but overall, rectal indomethacin after ERCP significantly reduced PEP in high-risk patients (9%) compared to placebo (19%).…”

Is rectal indomethacin ineffective in the prevention of post‐endoscopic retrograde cholangiopancreatography pancreatitis in the general population?

“…We read with interest the meta‐analyses by Feng et al . and by Inamdar et al ., objecting to the use of rectal indomethacin for post‐endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prophylaxis in general patients and in ‘average‐risk patients’, respectively, through analyzing the same six randomized controlled trials (RCT) where patients were unselected.…”

“…Feng et al . corrected the inconsistency and made the first meta‐analysis investigating the effectiveness of rectal indomethacin for PEP prophylaxis in the general population.…”

Toward routine use of non‐steroidal anti‐inflammatory drugs for patients undergoing endoscopic retrograde cholangiopancreatography

“…In recent issues of Digestive Endoscopy , two meta‐analyses evaluating rectal NSAIDs for prevention of PEP in consecutive patients rather than in selected high‐risk populations were independently reported. Feng and colleagues conducted a meta‐analysis of six RCT which evaluated rectal indomethacin for a total of 2473 consecutive patients undergoing ERCP . No statistically significant difference was observed in the overall rate of PEP (summary OR comparing NSAIDs with placebo, 0.67; 95% CI, 0.46–1.00) with no statistical evidence on between‐study heterogeneity.…”

“…Feng et al . adopted the random‐effects model to pool the treatment effect sizes and did not find statistically significant evidence supporting the effectiveness of rectal NSAIDs on prevention of PEP . Their conclusions were based on a wide range of predicted intervals which estimates the distribution of the true effect size (in which the results of a future study would fall).…”